Digestive disorders associated with the consumption of palm fiber (Elaeis guineensis) in feedlot cattle / Distúrbios digestivos associados ao consumo de fibra de dendê (Elaeis guineensis) em bovinos criados em regime de confinamento

Digestive disorders in cattle are associated with the breeding system and feed provided to the animals. Abomasal compaction is primarily related to the ingestion of forage with elevated levels of lignin, low quality, and difficult digestibility. In addition, the excess of fibrous food in the diet can lead to phytobezoars that may be responsible for intestinal obstruction disorders. This study aimed to describe pathological and clinical aspects of an outbreak of digestive disorders associated with the consumption of palm fiber (Elaeis guineensis). The outbreak struck a herd of 499 animals raised in a feedlot system after a change in diet that included an increase in the amount of palm fiber. Forty (8.01%) animals showed clinical signs such as fattening and regurgitation during rumination, and 21 (4.2%) animals died later. The cattle affected presented with apathy, emaciation, dehydration, distended abdomen, incomplete or absent ruminal movements, and congestive mucosa. Three animals were submitted to necropsy, and distended rumen and reticulum has a large amount of brownish liquid, long and tangled vegetable fibers with sand and stones. In two animals, the omasum had many rounded structures measuring approximately 5cm in diameter, made of vegetable fiber (phytobezoars). Abomasum of animals had similar material to the rumen, and one animal had compressed content. In two animals, dilatation was observed in the small intestine, and in the opening, the total obstruction of the lumen by phytobezoar was observed. During the follow-up of the slaughter of 76 cattle, 15 (19.7%) had phytobezoars of different sizes in the omasum and abomasum. The increased amount of oil palm fiber in animal feeding favored the occurrence of compression abomasum and intestinal obstruction phytobezoa, causing significant economic losses.(AU)

Alguns distúrbios digestivos em bovinos podem estar associados ao sistema de criação e alimentação dos animais. Entre estes estão à compactação de abomaso e a obstrução intestinal por fitobezoários, ambas relacionadas principalmente com a ingestão de alimentos com altos níveis de lignina e, consequentemente, de difícil digestibilidade. Neste trabalho são descritos os aspectos clínicos e patológicos de um surto de distúrbios digestivos em bovinos associados ao consumo de fibra de dendê (Elaeis guineensis). O surto acometeu um rebanho de 499 bovinos, criados em sistema de confinamento, após uma mudança na dieta que incluiu o aumento na quantidade de fibra de dendê. Após a mudança 40 animais (8,01%) apresentaram diarreia, distensão abdominal e regurgitação durante a ruminação e 21 animais (4,2%) morreram. Os bovinos examinados clinicamente apresentavam sinais de apatia, emagrecimento, desidratação, abdômen distendido, movimentos ruminais incompletos e ausentes, além de mucosas congestas. Três animais foram submetidos à necropsia e observou-se rúmen e reticulo distendidos e com grande quantidade de líquido acastanhado, fibras vegetais longas e emaranhadas e presença de areia e pedras. Em dois animais o omaso continha grande número de estruturas arredondadas medindo aproximadamente 5cm de diâmetro, constituídas de fibras vegetais (fitobezoários). No abomaso dos animais havia material semelhante ao do rúmen, sendo que um animal apresentou conteúdo compactado e um deles também tinha fitobezoários. Em dois animais foram observadas dilatação e obstrução total do lúmen do intestino delgado por fitobezoários. Durante o acompanhamento do abate de 76 bovinos, 15 (19,7%) apresentavam fitobezoários de diferentes tamanhos no abomaso e omaso. O aumento da quantidade de fibra de dendê na alimentação dos animais favoreceu a ocorrência de casos de compactação de abomaso e obstrução intestinal por fitobezoários, ocasionando perdas econômicas significativas.(AU)

Phytobezoar induced small bowel obstruction: an uncommon cause of intestinal occlusion

A case of a 42-year-old female patient with a two-days diffuse colicky abdominal pain, nausea and three episodes of vomiting is presented. Furthermore, patient complained for inability to eat for almost a week. In addition, patient had a history of subtotal gastrectomy Billroth II-type, due to gastric ulcer six years ago. There were no other known co-morbidities. Except for a distended, somewhat painful abdomen and sluggish bowel sounds, the rest clinical examination was unremarkable. Plain abdominal X-ray and ultrasound findings agreed with the clinical suspicion of sub-acute small bowel obstruction probably due to post-operative adhesions. A conservative management was decided. However, the patient after an initial clinical improvement, had a relapse of symptoms with the first feeding attempt. A followed computed tomography of the abdomen revealed a well define, oval, mass-like containing mostly air bubbles lesion, occupying for approximately six centimeters long the jejunum lumen. The diagnosis of jejunal phytobezoar was set. In accordance of computed tomography diagnosis were the intra-operative findings and the post-operative histopathology.

Obstrucción intestinal por fitobezoar en una paciente con bypass gástrico laparoscópico en Y de Roux: reporte de un caso / Intestinal obstruction due to phytobezoar in a patient with laparoscopic gastric bypass in Roux-en-Y: case report

INTRODUCCIÓN: Los bezoares son una etiología infrecuente de obstrucción intestinal (OI) posterior a un bypass gástrico laparoscópico en Y de Roux (BGLYR). OBJETIVO: Describir un caso clínico de OI debido a un fitobezoar en un sitio infrecuente, en una paciente 2 años después de un BGLYR. CASO CLÍNICO: Paciente de sexo femenino con antecedente de BGLYR hace 2 años y cuadro de obstrucción intestinal causado por fitobezoar. DISCUSIÓN: Se discuten los factores que pueden contribuir a la formación del bezoar en este caso y estrategias para su prevención. Se destaca la importancia del estudio imagenológico y de la exploración quirúrgica oportuna.

BACKGROUND: Bezoars are an infrequent aetiology of bowel obstruction after a laparoscopic Roux-en-Y gastric bypass (LRYGB). OBJECTIVE: To describe a clinical case of bowel obstruction due to a phytobezoar in an uncommon site, in a patient 2 years after a LRYGB. CASE REPORT: A female patient with a history of LRYGB 2 years ago and bowel obstruction due to phytobezoar. DISCUSSION: Factors that can contribute to the formation of bezoar in this case and strategies for its prevention are discussed. The importance of the imaging study and timely surgical exploration is emphasized.

Clinics in diagnostic imaging (198). Small bowel obstruction secondary to a bezoar

A 60-year-old man presented with abdominal pain. He was later diagnosed on imaging to have high-grade small bowel obstruction. The patient underwent surgery, and a hard, rounded bezoar resembling the endosperm of Nypa fruticans, colloquially known as attap chee, was found at the point of obstruction. Small bowel obstruction is a common acute surgical condition with multiple causes, including bezoars. We discuss the typical imaging features of bezoars causing small bowel obstruction as well as potential pitfalls that can mimic the appearance of a bezoar.

Oclusión intestinal mecánica por fitobezoar / Mechanical intestinal occlusion by phytobezoar

Los bezoares son recolecciones de material orgánico no digerible, que luego de ser ingerido, se acumulan con el tiempo en el estómago o intestino delgado. La presentación más común del bezoar es en la forma de fitobezoar, el cual es causado por la acumulación de partículas sin digerir de origen vegetal. Los fitobezoares son responsables de sólo 0,4-4 por ciento de todas las obstrucciones intestinales. Se presenta un paciente masculino de 51 años hospitalizado e intervenido quirúrgicamente por presentar una oclusión intestinal que en el acto operatorio se constató que la causa fue por fitobezoar. La presentación como oclusión intestinal es muy rara, dado que sigue un curso insidioso y progresivo. El diagnóstico de oclusión intestinal por bezoar puede resultar muy difícil, ya que es una entidad muy poco frecuente y la historia de la ingesta de estos materiales es rara vez expresada espontáneamente. El diagnóstico de oclusión intestinal secundaria a fitobezoar requiere de tratamiento quirúrgico precoz, ya que su retraso conlleva a una elevada morbimortalidad. El fitobezoar es una causa rara de obstrucción de intestino delgado. Su sospecha clínica es frecuentemente pasada por alto. Es importante conocer la conducta a seguir en estos casos para garantizar un correcto tratamiento(AU)

Bezoars are collections of indigestible organic material, which accumulate in the stomach or small intestine after being ingested. The most common presentation of bezoar is in the form of phytobezoar, which is caused by the accumulation of undigested particles of vegetable origin. Phytobezoars are responsible for 0.4-4 percent of all intestinal obstructions. A 51-year-old male patient was hospitalized and operated, after presentation with an intestinal occlusion. During the surgical procedure, the cause was found to be fitobezoar. This type of intestinal obstruction is much rare; it follows an insidious and progressive course. Its diagnosis can be much difficult; history of disagreement regarding these materials is rarely expressed by patients spontaneously. The diagnosis of intestinal secondary occlusion by phytobezoar requires early surgical treatment because the delay has led to high morbidity and mortality. The phytobezoar is a rare cause of small bowel obstruction. Ii is often ruled out as clinical suspicion. It is important to know how to perform in these cases, in order to ensure proper treatment(AU)

Obstrucción intestinal por fitobezoar en un divertículo de Meckel / Phytobezoar-caused intestinal obstruction in a Meckel's diverticulum

El divertículo de Meckel es la anomalía más frecuente del aparato gastrointestinal y, aunque ocurre igualmente en ambos sexos, la presentación de síntomas y complicaciones es más frecuente en el sexo masculino. La obstrucción intestinal es la complicación más común en el adulto. Se reporta el caso clínico de un paciente de 41 años que se presenta con dolor abdominal y vómitos de 12 h de evolución, al cual se le diagnostica una obstrucción intestinal mecánica. La radiografía de abdomen demostró niveles hidroaéreos compatibles con el diagnóstico de obstrucción intestinal. Los hallazgos de la cirugía fueron asas de yeyuno e íleon muy dilatadas, con gran cantidad de líquido en su interior y edema, lo cual fue provocado por un fitobezoar -mayormente de fibras de mango- que ocupaba la luz de un divertículo de Meckel de base ancha. Se resecó un segmento intestinal de 6 cm, donde estaba la base del divertículo, y se practicó una anastomosis primaria en dos planos con sutura discontinua de ácido poliglicólico. El paciente se recuperó sin complicaciones en el posoperatorio(AU)

Meckel's diverticulum is considered the most frequent gastrointestinal anomaly, it occurs equally in both sexes; however, the onset of symptoms and complications are more frequent in male patients Intestinal obstruction is the most common complication in adults. This is the report of a 41-years old patient, who presented with abdominal pain and vomiting for 12 hours; he was diagnosed as mechanical intestinal obstruction. The abdominal X-ray showed fluid levels compatible with the diagnosis of intestinal obstruction. The findings at surgery were dilated jejunum and ileum loops, with lots of liquid inside and edema caused by a phytobezoar (from mango fibers mainly) that occupied the broad-base Meckel diverticulum lumen. A 6 cm intestinal portion was excised from the diverticulum basis, and it was necessary to perform primary anastomosis with polyglycol acid discontinuous suture. The patient recovered without further complications postoperatively(AU)

Extremely rare case of extrahepatic duct phytobezoar treated with intraoperative transenteral endoscopy

Phytobezoar is a rare cause of gastro-intestinal tract obstruction. Common sites of phytobezoar are the stomach and small bowel. Naturally, extrahepatic duct phytobezoar is near impossible due to anatomical structure and location such as ampulla of vater, common bile duct and bifurcation of bile duct. Here, we present an extremely rare case of extrahepatic duct phytobezoar that resulted in abdominal pain. We successfully treated the case with extraoperative transenteral endoscopic removal of phytobezoar. For its great rarity and particular treatment approach, we report this case with review of literature.

A Large-Sized Phytobezoar Located on the Rare Site of the Gastrointestinal Tract

Bezoars are concretions of undigested material and are most often observed in the stomach. They can occur at any site in the gastrointestinal tract; however, duodenal localization is very rare. We report the case of a 71-year-old male who had undergone subtotal gastrectomy with gastroduodenostomy and experienced severe epigastric discomfort, abdominal pain, and vomiting for a few days. An approximately 7x8 cm-sized mass was found on an abdominal computed tomography scan. On following endoscopy, a large bezoar was revealed in the duodenum and was removed using an endoscopic removal technique, assisted by a large amount of Coca-Cola infusion.

Gastric Outlet Obstruction by Impacted Phytobezoar at the Normal Duodenal Bulb

Phytobezoars are the most common bezoars composed of non-digestible food materials, such as fiber, seeds, skin of fruits. The predisposing factors of bezoars are altered gastrointestinal motility and anatomy. It is uncommon for bezoars occurring in patient with normal gastric anatomy to cause impaction on the duodenal bulb. We experienced a phytobezoar at the duodenal bulb causing gastric outlet obstruction in a patient who had no predisposing factors. The patient was treated by endoscopic removal.

A Case of Colonic Obstruction Due to Phytobezoars / 대한소화기내시경학회지

Colonic phytobezoars are defined as conglomerate masses of fruit or vegetable matter in the colon, and these have rarely reported as a cause of colon obstruction. Because it is extremely rare, its correct diagnosis might be delayed even with the aid of abdominal computed tomography. We report here on a case of diagnosed colonic obstruction due to colonic phytobezoars in a 67-year-old female with diabetic end stage renal disease and chronic constipation. Although abdomino-pelvic computed tomography did not demonstrate the presence of phytobezoars, multiple phytobezoars impacted in the colon were found and these were removed by colonoscopy. This is a rare case in that colonic obstruction due to phytobezoar was diagnosed early and it was treated by colonoscopy.

Bezoar de madeira em trato gastrointestinal: relato de caso e revisão da literatura / Wood bezoar in the gastrointestinal tract: case report and literature review

INTRODUÇÃO: Bezoares são concreções de material animal, vegetal ou mineral retidas do tubo digestivo, sendo mais comuns fitobezoares e tricobezoares. Eles são causadores de várias doenças digestivas, incluindo obstruções, intussuscepções, sangramentos, perfurações, além de enteropatias, pancreatites, apendicites, icterícia obstrutiva e outras. OBJETIVO: Fazer revisão de literatura e apresentar um caso de paciente psiquiátrica com volumoso bezoar de madeira. RELATO DO CASO: Mulher de 20 anos portadora de distúrbio neuropsiquiátrico tem história de ingestão de palitos de fósforos e lápis de cor durante quatro anos. Foi admitida com queixa de plenitude, dor abdominal e vômitos. Ao exame apresentava-se hipocorada, emagrecida, abdômen levemente distendido e doloroso. Estudo radiológico revelou numerosa quantidade de corpo estranho impactado na região gástrica atingindo porção proximal do intestino delgado. Realizado tratamento com óleo mineral e soro fisiológico através de gavagem, sendo eliminado grande número de fitobezoares nas fezes. CONCLUSÃO: A associação da patologia bezoar com distúrbios psiquiátricos é relevante, podendo apresentar recorrências. Estes pacientes sempre que possível devem ser tratados de modo conservador, sendo a endoscopia o método de escolha, apesar de estar limitada à natureza e a quantidade dos bezoares. A remoção cirúrgica tem na gastrotomia anterior longitudinal e a ordenha cautelosa o procedimento de escolha.

BACKGROUND: Bezoars consist of animal, vegetable or mineral fiber concretions found in the digestive tract, considered to be phytobezoars and trichobezoars the most common forms of presentation. Bezoars cause a number of digestive pathologies including obstructions, intussusceptions, bleeding, perforations as well as enteropathies, pancreatitis, appendicitis, obstructive jaundice and others. Aim - Literature review and case report of a psychiatric patient presenting a large wood bezoar. CASE REPORT: R.F.L, a 20-year-old female, presenting neuropsychiatric disorder and history of ingesting matchsticks and colored pencils for over four years. She was admitted to our service feeling bloated, with abdominal pain and vomiting. Physical examination showed thin patient, pale skin, and slightly distended and painful abdomen. X-ray study showed numerous foreign bodies impacted in gastric region reaching the proximal section of the small intestine. She received tube feeding containing mineral oil and saline solution that resulted in elimination of a large amount of phytobezoars within the excrements. CONCLUSION: The association of bezoars with psychiatric disorders is relevant and may be recurrent. If possible these patients should be treated conservatively. Endoscopy has been shown to be the technique of choice, although its limitation depends on nature and quantity of bezoars. Surgical removal consists of longitudinal anterior gastrostomy as the preferred surgical procedure.

Phytobezoar Induced Ileal Obstruction in Children - Report of Two Cases

Two cases of small bowel obstruction ( SBO) in children induced by phytobezoar impaction are reported. Both the children were between 3-4 yrs of age and had no history of any previous intra-abdominal operation. Preoperative diagnosis was not possible in either case. Both the cases were diagnosed at laparotomy and obstruction was relieved by disintegration of the phytobezoar mass. Postoperatively, after specific questioning suggestive history of Carissa Opaca (Garna) ingestion, 24 hrs before onset of symptoms was obtained from the parents.

Extração de fitobezoar gástrico por videolaparoscopia: considerações técnicas originais / Videolaparoscopic extraction of gastric phytobezoar: original technical aspects

Videolaparoscopic surgery has been used for treatment of almost all surgical abdominal diseases, mainly where there are no large ressections, or operative field is limited. In these situations, laparoscopic surgery has the advantages of less morbidity, quick recovery and good cosmetic results. Bezoars removal, or its mobilization, is probably included in these possible proceedings. Three non-laparotomic procedures were described: 1. endoscopic-laparoscopic; 2. videolaparoscopy and mobilization of intestinal bezoar to the cecum; 3. laparoscopy and gastrotomy for bezoar removal, through suprapubic incision or the umbilical punction. There have been only two publications describing the videolaparoscopic method for bezoar removal, and the methods applied can be complications or morbidity related. We describe one case where the applied technique is simple and easy to perform, time saving and probably less complications-related. This technique, with four trocars, utilized a plastic bag besides the stomach to be opened, followed by gastrotomy, bezoar removal and immediate introduction in the plastic bag, suture of gastrotomy and removal through the left subcostal trocar. This technique was feasible and easy to perform, with short operative time, and there were no intra or post-operative complications; the patient was discharged in the second post-operative day, and is without further problems after one year follow-up. We believe that this could be an adequate technique to perform laparoscopic gastric bezoar removal, and the rigid sequence of operative events allows a quick procedure, with minimal contamination. The videolaparoscopy seems to be an adequate access to surgical treatment of gastro-intestinal bezoars, with or without obstruction, and should be the ellected the procedure of choice to begin the surgical treatment, with convertion to laparotomy in case of any intra-operative adversity.

Small Intestinal Obstruction due to Phytobezoars: Case reports / 대한소화기내시경학회지

Phytobezoars are the most common type of bezoars composed of nondigestible food material. They are usually formed in stomach and do not migrate to the other intestinal tract. Recently, we experienced two cases of small bowel phytobezoars resulting in obstruction. The first case is a 72-year-old male patient who had no previous history of surgery. He had poor dentition, and the history of eating dry persimmons 20 days before the onset of symptoms. The phytobezoar (4 X 3 cm) obstructed the terminal ileum. Colonoscopic removal was performed successfully. The second case is a 45-year-old male patient undergone previous vagotomy and pyloroplasty for duodenal ulcer perforation. He had a huge phytobezoar (10 X 6 cm) in stomach, which was treated by endoscopic removal. After incomplete endoscopic treatment, it moved into the proximal jejunum and obstructed the lumen. It was removed by operation.